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> > > > > Controlling her arthritis helped Emily have a successful pregnancy

Controlling her arthritis helped Emily have a successful pregnancy

When Emily and her partner Nick were worried her arthritis might make having a baby difficult, they went to see a specialist to discuss their options.

The couple were relieved to hear that despite Emily's rheumatoid arthritis they still had every chance of starting a family.

Planning ahead

Their careful and sensible planning has paid off and Emily and Nick were delighted with the safe arrival of their healthy and beautiful son Thomas.

Emily, who was 36 when she had Thomas, first started to have symptoms when she was 21 and she was diagnosed with the inflammatory form of arthritis at the age of 24.

Over the years, Emily's condition has been quite debilitating and at times it has caused her difficulties walking.

One of Emily's early concerns after being told that she had arthritis was whether or not she could have children, as she has always wanted to have a family.

With this in mind Emily and Nick went to see Dr Ian Giles, a consultant rheumatologist who has developed a specialist rheumatology-obstetric clinic with colleagues in women's health at University College London Hospitals.

Emily said: "We had a big chat with Dr Giles about all of this before trying. We talked about what we could do, the latest thinking and the latest stats, and what the chances were of me having a flare-up."

Making an informed choice

Emily's arthritis was quiet before she conceived, and it can be a good idea for a woman to choose a time when her arthritis is quiet or in remission to try for a baby.

Emily said: "It was nice to be able to make an informed choice, and I decided to stay on the medication up until the end of the second trimester.

"Since coming off the medication, I haven't had any problems.

"I had morning sickness, but I haven't had any problems as a result of my condition before or after coming off the medication. I have had a couple of slight twinges in my knee, though that might have been due to the pregnancy itself."

The drug that Emily continued to take until six months into her pregnancy was an anti-TNF drug called adalimumab

Latest medical thinking

Emily's approach has been in line with the latest thinking from the British Society for Rheumatology (BSR), which recently released new guidelines for healthcare professionals treating women with arthritis who are trying to conceive, are pregnant or are breastfeeding.

This latest thinking, which is evidence based, says that it's very important to control the mother's arthritis and maintain her health during pregnancy. The strong evidence is that this is not only the right thing to do for the mother, but also for the baby.

The guidelines are the result of three years of research by a BSR working group which reviewed all relevant published information on this topic.

While the warnings around some drugs remain, for other medications, including several of the newer biologic drugs, there is a growing evidence base that women can safely take these drugs during part or all of their pregnancy.

The lead author of the guidelines was the specialist that Emily went to see, Dr Giles.

He stressed the importance of controlling women's arthritis during pregnancy with medicines that are safe in pregnancy rather than stopping them and allowing their disease to become active.

Dr Giles said: "Active disease can be very harmful for the pregnancy. With rheumatoid arthritis, modern studies have shown that it does not spontaneously improve in pregnancy in as many patients as was previously thought and pregnancy problems, such as premature deliveries and reduced growth for babies is now known to be associated with disease flares.

"Women should not simply stop all medications during pregnancy.

"The important thing for women with arthritis is to plan ahead and talk to their medical team about their options."

This is exactly what Emily and Nick did and they are delighted with the outcome.

Excitement over new arrival

Thomas was born at the end of March 2016, weighing 9 lbs, and Emily and Nick are thoroughly enjoying life with their healthy new arrival.

Emily wanted to breastfeed, and decided not to go back on medication straight away for this reason. There is limited information available about the use of adalimumab by women who are breastfeeding. The guidelines state that small amounts of the drug may pass into the breast milk, but this doesn't appear to be harmful.

Emily said: "I have decided to go down the route of not going back on the medication and then seeing how it goes and knowing that going back on the medication is an option, should I need it."

Emily is adjusting perfectly to life as a new mother.

She said: "When the health visitor came she said that Thomas is very authoritative in the way he demands attention.

"I think that was a very polite way of saying that he can cry very loudly.

"Nick and I are absolutely over the moon at the arrival of Thomas."


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